NEW PATIENT FORMS

If you are a new patient, please click on the link below to get started with your intake:

  1. Mental Health New Patient Intake Form
  1. Substance Use New Patient Intake Form

OTHER FORMS

  1. Release of Information Form
  2. Notice of Privacy Practices
  3. PHQ9 (Depression Screening)
  4. GAD7 (Anxiety Screening)

Substance Use Treatment (SUD)

  1. Substance Use New Patient Intake Form Click here

SUD Telemedicine Link

  1. Please click the following link if you are normally seen in-person at one our of our clinics but have been instructed to log in remotely today click here.
  2. Please click the following link if you do not live in the vicinity of one of our clinics and are normally seen remotely click here.
  3. Please click the following link if you enrolled through the KLINIC Platform click here.

Mental Health Treatment

  1. Mental Health New Patient Intake Form Click here

Telemedicine Link

  1. Please click the following link for your MENTAL HEALTH evaluation or follow-up visit click here.

Other Forms:

Attention All Patients: Please do not fill these forms out unless specifically instructed to doso by a provider or staff member.

  1. Release of Information Form click here.
  2. Notice of Privacy Practices click here.
  3. PHQ9 click here.
  4. GAD7 click here.